Introduction

Americans have been hearing about the evils of cholesterol for at least the past 30 years. And the good news is that the naysaying seems to have had at least some positive effect: deaths from heart disease have been slowly decreasing. But we shouldn’t break out the party hats and confetti prematurely, because the news could be a lot better. One out of every three Americans has cardiovascular disease.

And in fact, one very large area for concern may be misinformation that Americans have been receiving for far too long about the alleged connection between cholesterol and heart disease. As it turns out, the relationship between the two may be far more complicated than we’ve been lead to believe.

The manufacturers of cholesterol-lowering drugs like Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin) would certainly like us to think that high cholesterol causes heart attacks, and conversely that by lowering cholesterol, one eliminates the risk of a major coronary event. They seem to have convinced a lot of people: these drugs are currently the highest grossing worldwide. We would like nothing more than if popping a pill could prevent a heart attack with no adverse side effects. Unfortunately, the reality is a bit fuzzier.

As it turns out, the cholesterol dogma may be wrong in all kinds of ways. For one thing, the notion that eating a diet high in cholesterol–full of eggs, meat, and fats–is a cardinal cholesterol sin, sure to send you straight to the ER, has been reexamined in the wake of contrary evidence. Several studies have shown that a low-carb diet, like Atkins or the Zone, led to greater weight loss, reduction in serum triglycerides, and an increase in good HDL cholesterol than a low-fat diet. One amazing study of overweight patients found that they shed pounds and improved their lipid profiles by taking on a diet that some doctors might see as suicidal: eating two to four eggs a day, and half a pound of red meat at every single meal. Half a pound!

Higher-fat diets seem to raise good HDL cholesterol better than low-fat diets, which may help explain why they also seem to give those following them better scores on heart-disease risk factors than those on Dean Ornish-style low-fat, carbohydrate-heavy diets.

And contrary to the medical community’s long-held belief that low-fat = good health, several high-profile studies, including the Women’s Health Initiative with over 48,000 female participants over 50 years old, have demonstrated no statistically significant benefit to a low-fat, high-veggie diet for lowering the risks of heart attack, stroke, breast cancer and colorectal cancer.

Another startling discovery to come out of studies on cholesterol is that daring to push it as low as you can go may indeed be a gamble. Some people are very surprised to learn that our bodies need cholesterol to function: it’s the building block for things like vitamin D and sex hormones such as estrogen and testosterone. It’s also vital for our nervous systems, particularly in the brain. When there isn’t enough cholesterol in your body, synapses (the way neurons communicate with other neurons) break down. As you might imagine, then, having too little cholesterol may also be a bad thing.

At least two studies have provided evidence that there may be a link between very low cholesterol and the risk of bleeding stroke, especially for women with high blood pressure. One study of Japanese-American men found that those with the lowest cholesterol levels were more likely to die earlier. Those with cholesterol in the 188-209 range seemed to fare better. For people over 70, especially women, trying to bring cholesterol down aggressively might be counterproductive. There is very little evidence that lowering cholesterol in an older woman will extend her life expectancy significantly.

Of course none of this is meant to suggest that we shouldn’t pay attention to our lipid levels, or that we should gorge on hot dogs and hot fudge sundaes. Cholesterol that is too high is clearly dangerous and can lead to an increased risk for heart attack. But what has become clear through the haze of cholesterol confusion is that how much fat you eat matters much less than what kind.

Heart disease is still the number one killer in America today, despite the billions spent annually on cholesterollowering drugs. More than one million people will have a heart attack this year–and 650,000 will die from a “coronary event.” That’s about one every minute. And nearly half of all heart attack sufferers have normal cholesterol levels.

Some Risk Factors

  • High level of C-reactive protein (CRP)
  • Smoking
  • Hostility or anger
  • High LDL cholesterol
  • Low HDL cholesterol
  • High level of very low-density (VLDL) cholesterol
  • High triglycerides
  • Elevated lipoprotein (a)
  • Being overweight
  • High homocysteine
  • Too much iron
  • High blood pressure
  • Lack of physical activity
  • Genes & family history
  • Diabetes & insulin resistance
  • High uric acid level
  • Depression
  • Lack of a social network
  • Socio-economic status
  • Stress & anxiety
  • Hormone Replacement Therapy (HRT)

Publication Information

Published on: November 8th, 2019 | Last Updated: November 28th, 2019
Publisher: The People's Pharmacy

© 2021 The People's Pharmacy

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